What is considered BEST PRACTICE for a Dispensing Optician
Our New Zealand Association is working on a code of conduct, or minimum standards for dispensing opticians. We've come up with the following document, however I would be very interested in discussing this with anyone - what ways we can improve on this, what's missing, what shouldn't be there, etc.
Thank you for your help!
Mary Sue Hopper, (R.D.O. NZ)
Triage-Clinical:
1. Create a practice policy for Triage in combination with your practice optometrist. Ensure that your practice staff is aware of your knowledge in this area – and what patient symptoms you should be made aware of when the optometrist is away or busy. Endeavour to be the main information point for triage – all queries should be run through you as you are available and required.
Dispensing:
1. Take monocular PD’s for distance and near using a pupilometer for all orders
2. Adjust the frame – ensure bridge fit, pantoscopic tilt, and BVD are all at their optimum position
3. Mark the horizontal centre line (datum) on the dummy lenses of the frame and draw a vertical line at the monocular PDs, marking off each 2mm above and below datum with a fine-tipped pen. Or use an HSM.
4. With your head and your client’s head at the same level, (not the point that is level with the centre of the pupil), you can look into the wall mirrors to help ensure that your heights are the same. Ideally you should be sitting on an adjustable stool.
5. Check your measurement by engaging your client in conversation and continuing to note the relevant marking.
6. For all single vision aspheric lenses you must use the method above to measure heights for the principal axis/centre of rotation for single vision. This is done with the lenses perpendicular to the floor. Refer to “Practical Optical Dispensing” by David Wilson, page 123-132.
7. Order the lens position according to your monocular PDs and the heights according to the final positioning of the markings.
Adjustments – and Delivering Spectacles
1. If a patient presents for an adjustment, we need to first identify the type of lens they are wearing, and then mark progressives for fitting cross. Note state of the lenses, and discuss this with the patient – they may not realise their lenses are damaged, worn, etc.
2. Examine the horizontal alignment
a. If bifocals, check that the segs are equidistant from the bottom lids.
b. If single vision, check the position of the centres
c. If progressive, check that the fitting crosses are in front of the pupils
2. Examine the pantoscopic tilt
a. A pantoscopic tilt from 10 to 12 is recommended for all progressives, any deviation at the time of dispensing should have been noted on the client file – and the dispensing optician should verify that the pantoscopic tilt is identical to that at the time of dispensing.
b. Ensure the BVD is accurate
3. Examine the temple width
a. From the front of the frame, check that both lenses are of an equal distance from each eye – that is the vertex distances are equal when observed from above
b. Check that there is no temple pressure forward of the ears and that the temple width pressure against the head is accurate.
c. The correct temple width of a frame is approximately 5 mm narrower than the client’s head width. Spring hinged temples should not be set at any different ration – use the same 5 mm narrower than head width as your guide.
4. Examine the temple bow
a. Ensure that the shape or bow of the temples conforms to your client’s head
5. Examine the length to bend – “triangle of force”
a. Bend the temple so that it follows the line of the back of your client’s ear – this bend should start 2mm behind the top of the ear to allow for slight facial movements.
6. Adjust the anatomical bend
a. Adjust the shape of the temple to follow the depressions or bumps in the mastoid area behind the ears – the more even the pressure the greater the comfort
b. Remember the pressure needs to be even along the back of the ear – in order to create that “suction” effect which holds the frame in place and provides the most comfort for the wearer.
7. Once all adjustments have been done, and heights or fitting crosses checked, check the distance VA’s and near VA’s depending on the RX with patients.
8. If any drop in VA is noted, this should be reported to the optometrist as soon as possible. If a dispensing optician has followed the above procedure and all prescription requirements were verified and checked at final inspection the job then is referred back to the prescriber.
9. Explain how the lenses are cared for –
a. Never clean with hot or warm water
b. Use only cold water to clean the lenses with liquid soap – no additives in the soap, as aloe can destroy a coating quickly, along with some other abrasive cleaning agents.
c. Recommend your own lens cleaner
d. Show them how to use their case
e. Suggest coming back in 3 months for a warrant of fitness on their specs (you can clean them, replace worn nose pads, etc – but better yet – you can get another chance to talk to them about another set of specs/contacts/sunnies/etc.
f. Do not rub lenses with pressure – the coating is a finish, and any finish is able to be rubbed through with repeated vigorous cleaning. Gentle wipes with the cloth we provide are best
g. Instruct them on cleaning their lens cloth – normal laundry, etc.
10. Explain how they will use the lenses:
a. Progressives
b. Single vision distance
c. Reading
d. Occupational – etc.
Checking work – Verifying Lens Orders Received:
1. Check lens surfaces for defects before neutralising
2. Check powers, sph, cyl, axis, prism, etc
3. Check edge and centre thickness
4. Check base curves as required by RX
5. Check materials
6. Check treatments – coatings, etc.
7. Check for transitions if ordered
8. Check surface – front and back – after neutralising
9. Check lens fit and shape
10. Ensure the lenses are not buckling, or too small
11. Check frame size, model, colour is according to order
12. Clean
13. Remark heights on progs, or SV Aspheric, etc.
14. Match case to frame
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Originally Posted by chip anderson
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